Attachment A INTEGRATED PEST I\4ANAGEMENT NOTICE FOR ELEMENTARY SCHOOLS: Maryland Law requires that school staff and parents/guardians of all students be notified prior to planned pesticide applications in the school or on school grounds, or within 24 hours of an emergency application. Without exception, notices will be sent to all parents/guardians and circulated among school staff members. FOR MIDDLE SCHOOLS, HIGH SCHOOLS, AND ADMINISTRATIVE CENTERS: Maryland Law requires that school-based staffand parents/guardians of middle or high school students and staff at administrative centers who wish to be notified prior to pesticide applications in the building or on the grounds must request that they be placed on the school's pesticide notification list. To do so, please fill out the enrollment form attached to this notice and return it to your school or administrative center. ALL: The Integrated Pest Management (IPM) Program implemented in Montgomery County Public Schools is a proactive approach to insect and rodent control in school facilities and on school grounds. The IPM Program includes frequent inspections of all school facilities to look for pests and conditions that favor pest invasions. As a first step in pest control, the IPM approach employs a number of preventive strategies and alternatives to pesticide application such as employee education, source reduction, inspection, identification ofpotential problem areas, and improved sanitation. Each strategy is monitored and evaluated, and modifications are made if necessary. Pesticides will be used only as a last resort or in an emergency situation. FOR Pesticides and bait stations, by product name and common narne, which may be used in buildings or on grounds during the school year include, but are not limited to: Product Name 4-the-birds II Arilon Avert cockroach bait station Avert cockroach crack and crevice bait 310 Avert dry flowable roach bait Avitrol Cynoff insecticide Deltadust Demon WP Drione insecticide Dylox 6.2 grams Firstline terrnite bait stations First Strike Gentrol IGR concentrate Gentrol point source roach control Golden malrin fly bait Liqua-tox II Common Name Polybutene Indoxacarb Abamectin Abamectin Abamectin Aminopyridine Cypermethrin Deltamethrin Cypermethrin Pyrethrins Trichlorfon Sulfluramid Difethialone Hydroprene Hydropene Methomyl thioacetimidate Sodium diphacinone Maxforce FC ant bait stations Ir4axforce granular ant bait It4axforce roach bait stations Maxforce roach killer bait gel Niban granular bait Premise 75 Premise foam insecticide PT 240 Perrna Dust PT 515 wasp freeze PT565 plus XLO Ratsorb Round up Pro Mar Rozol tracking po\ /der Shatter termite bait cartridge Suspend SC Talon G Talstar Professional multi-insecticide Termidor SC terrniticide Terro PCO ant bait Timbor Uncle Albert's ant bait Weatherblok bait ZP tracking powder Fiprcnil H;-drameth;r'ion Hyciramethl,lnon Hydramethylnon Orthoboric acid Imidacioprid ImiCacloprid Methyl Chloroform D-trans allethrin Pyrethrins Camphoraceous Glyphosate Chlorophacinone Hexaflumuron Deltamethrin Brodifacourn Bifenthrin Fipronil Sodium borate Disodium octaborate tetrahydrate Disodium octaborate tetrahydrate Brodifacoum Zinc phosphide Mrs. Teresa M. Baumanis, environmental health specialist, Environmental ServicesAndoor Air Quality, maintains copies of Material Safety Data Sheets (MSDS) and product labels for all pesticides and bait stations used in buildings or on grounds. If you would like to review this information, please contact her at 301-670-8238 or via e-mail. Public comments regarding the Integrated Pest Management program may be addressed at scheduled Board of Education meetings. Attachment B Please complete this form ONLY if you wanl to be notified prior to a pesticide application. MONTGOMERY COLINTY PUBLIC SCHOOLS PESTICIDE NOTIFICATION LIST ENROLLMENT FORM SECONDARY SCHOOLS AND ADMNISTRATIVE CENTERS School Year 2014-2015 SCHOOL OR CENTER: PARENT/GUARDIAN/S TAFF MEMBER NFORMATION (Circle one of the above) : Name: Address: City/StatelZip Code: Telephone: Day Evening STUDENT INFORMATION (IF APPLICABLE): Legal Name Registered with MCPS: Grade: Address: City/StatelZip Code: ADDITIONAL INFORMATION: Does the student or staff member have any known medical conditions that may be aggravated by the use of a pesticide? YES NO Is this information listed on your student's health card? YE,S NO school/facility. The form will be kept at the school/center for further reference. If you require additional information regarding the Integrated Pest Management Program and/or notification procedures for Montgomery County Public Schools, please contact Mrs. Teresa M. Baumanis, environmental health specialist, Environmental Services/Indoor Air Quality, at 301-670-8238 or via e-mail. Please return forms to your Attachment C MONTGOMERY COUNTY PUBLIC SCHOOLS NOTIFICACION DE ADMIMSTRACIoN INTEGRADA DE CONTROL DE PLAGAS PARA ESCUELAS ELEMENTALES: Las leyes de Maryland exigen que el personal escolar y los padres/guardianes de todos los estudiantes sean notificados antes de la aplicaci6n planificada de pesticidas en las escuelas o en los terrenos de las escuelas, o dentro de un periodo de veinticuatro (24) horas de una aplicaci6n de emergencia. Las notificaciones se enviar6n a todos los padres/guardianes y ser6n circuladas a todos los miembros del personal escolar, sin excepci6n. PARA ESCUELAS DE ENSENANZA MEDIA, ESCUELAS SECTINDARIAS Y CENTROS ADMINISTRATIVOS: Las leyes de Maryland exigen que el personal que trabaja en las escuelas y los padres/guardianes de estudiantes de escuelas de ensefianza media y secundarias, como tambi6n el personal que trabaja en centros administrativos y que desean ser notificados antes de la aplicaci6n de pesticidas en el edificio o los terrenos de su lugar de labores, deben solicitar ser colocados en la lista de notificaci6n sobre pesticidas. Para hacerlo, por favor complete el formulario de inscripci6n que se adjunta a esta notificaci6n y devu6lvalo a su escuela o centro administrativo. PARA TODOS: El programa Integrated Pest Management flPM) (administraci6n integrada de control de plagas) que se implementa en Montgomery County Public Schools es un enfoque proactivo hacia el control de insectos y roedores en instalaciones y terrenos escolares. El Programa IPM incluye inspecciones frecuentes en todas las instalaciones escolares para localizar pestes y condiciones que favorecen la invasi6n de pestes. Como un primer paso en el control de plagas, el enfoque IPM emplea diversas estrategias de prevenci6n y alternativas a la aplicaci6n de pesticidas, tales como: ensefianza a los empleados, reducci6n de lugares de infiltraci6n, inspecci6n, identificaci6n de 6reas que podrian presentar problemas potencialmente y mejoras en la higiene. Cada estrategia es vigilada y evaluada, y se realizan modificaciones segrin la necesidad. Los pesticidas serdn utilizados fnicamente como riltimo recurso o en una situaci6n considerada de emergencia. La siguiente es una lista de pesticidas y trampas por nombre del producto y su nombre comfn, que pueden ser utilizados en edificios o en los terrenos escolares durante el ciclo escolar, pero esta no es una lista exhaustiva: Nombre del Producto 4+he-birds Arilon II Avert, trampa para atrapar cucarachas Avert 310, trampa para cucarachas y cebo para grietas Avert, cebo para cucarachas de esparcimiento en seco Avitrol Cynoff Deltadust Demon WP Insecticida Drione Insecticida Nombre Comrin Polybutano Indoxacarb Abamectina Abamectina Abamectina Aminopiridina Cipermetrina Deltametrina Cipermetrina Piretrinas por favor, devuelva el formulario a su escuela o cento. El formulario deber6 mantenerse en la escuela o centro para futura referencia. Si usted requiere informaci6n adicional con respecto al progranra lntegrated Pest Management y/o los procedimientos de notificaci6n para Montgomery County Public Schools, rogarnos se ponga en contacto con Mn. Teresa Air Quality, ii4. Baumanis, environmental health specialist (especialista en salud ambiental), Environmental ServiceVlndoor llamando a1301470-8238, o por correo elect6nico. F+sticj_,$e $s-*tifise.t-**x Lls* Elrr*ll"Ll!t*r*t" s"srx* * $p.*n{*h Attachment D Porfanr complete este formulario SOLAMENTE si usted desea ser notificado/a anles que se aplique un pesticida MONTGOMERY COUNTY PUBLIC SCHOOLS SOBRE PESTICIDAS FORMULARIO DE INSCRIPCION NOTIFICACION LISTA DE E SCUELAS SECLTNDARIAS Y CENTRO S ADMINISTRATIVOS Ciclo Escol ar 207 4-201 5 ESCUELA O CENTRO: SCHOOL OR CENTER: INFoRMAcr6n ppl pADREA4ADRE/c uARDnNnnrcuBRo DEL PERSoNAL: PARENT/ GUARDIAN / STAFF MEMBER INFORMATION: (Marque con un circulo lo que corresponda a:riba) Nombre: Name: Domicilio: Address: Ciudad/Estado/Codi go Postal : City/State/Zip Code: Teldfono: Dia Noche Telephone: Day Evening INFORMACION DEL ESTUDIANTE (SI FUESE APLICABLE): STUDENT INFORMATION (IF APPLICABLE): NornbreLegal lnscrito con MCPS: Grado: Legal Name Registered with MCPS: Grade: Domicilio: Address: Ciudad/Estado/Codigo Postal : ciry/star elzip code: INFORMACION ADICIONAL: ADDITIONAL INFORMATION : ;Tiene el estudiante o miembro del personal alguna condici6n mddica que podria ser agravada por el uso de pesticidas? boes the student or staffmember have any known medical conditions that may be aggavated by the use of a pesticide? SV Yes NO/ No 6Est6 esta informaciSn en la tarjeta de salud de su estudiante? Is this information listed on your student's health card? SV Yes NO/ No